Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS
|
|
- Maryann Davidson
- 8 years ago
- Views:
Transcription
1 Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Clarksville-Montgomery County Employees Life Benefit Employee Spouse Dependent Amount Choice of $10,000 increments. Not to exceed 5 times your annual salary. Employees age 70 and older, maximum benefit is $30,000. Choice of $5,000 increments Employee must elect coverage for spouse to be eligible. Not to exceed 50% of employee elected amount. Minimum Amount $10,000 $5,000 $10,000 Maximum Amount $500,000 $250,000 $10,000 Guarantee Issue $200,000 under age 60 $10,000 age No Guarantee Issue age 70 and older AD&D Benefit Employee Spouse Amount Benefit Reduction Employee Benefits will reduce: Additional Benefits The benefit amount is equal to the life amount elected by you. Cost included in the schedule. At Age 70-Benefits will reduce to the lesser of one times basic annual earnings or $30,000, whichever is less Benefits terminate at retirement Accelerated Death Benefit Portability Conversion $100,000 under employee age 60 No Guarantee Issue employee age 60 and older Same as employee Spouse Eligibility Employee Spouse and Dependents All full-time active employees working 15 or more hours per week in an eligible class are eligible for coverage. A delayed effective date will apply if the employee is not actively at work. $250 Child: 14 days to 6 months $10,000 Child: 6 months to age 19 (to age 25 if full-time student) Newborn children to age 14 days are not eligible for a benefit. $10,000 At Employees Age 70-Benefits will reduce to the lesser of one times basic annual earnings or $30,000, whichever is less Benefits terminate at employee retirement Cannot be in a period of limited activity on the day coverage takes effect.
2 Clarksville-Montgomery County Employees Employee Premium Life with Accidental Death and Dismemberment Premium for sample benefit amounts Rates are based on 10 pay periods per year Employee and Spouse Premiums are calculated separately. Spouse premiums will be calculated based on employee age. Refer to Program Specifications for your maximum benefit amounts. Benefits and premium amounts reflect age reductions. AGE Rate per $1,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 < $1.44 $2.88 $4.32 $5.76 $7.20 $8.64 $10.08 $11.52 $12.96 $ $1.56 $3.12 $4.68 $6.24 $7.80 $9.36 $10.92 $12.48 $14.04 $ $1.92 $3.84 $5.76 $7.68 $9.60 $11.52 $13.44 $15.36 $17.28 $ $2.76 $5.52 $8.28 $11.04 $13.80 $16.56 $19.32 $22.08 $24.84 $ $4.20 $8.40 $12.60 $16.80 $21.00 $25.20 $29.40 $33.60 $37.80 $ $6.00 $12.00 $18.00 $24.00 $30.00 $36.00 $42.00 $48.00 $54.00 $ $8.64 $17.28 $25.92 $34.56 $43.20 $51.84 $60.48 $69.12 $77.76 $ $13.80 $27.60 $41.40 $55.20 $69.00 $82.80 $96.60 $ $ $ $24.48 $48.96 $73.44 $97.92 $ $ $ $ $ $ $34.32 $68.64 $ N/A N/A N/A N/A N/A N/A N/A $73.44 $ $ N/A N/A N/A N/A N/A N/A N/A This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. Example: Use this formula to calculate premium for benefit amounts over $100,000. Age Rate Per $1,000 X Benefit In $1,000 s = Cost Example: X 120 = $23.04 Dependent Children Rate = $2.40 per Pay Period X = Premium covers all dependent children regardless of the number of children.
3 Clarksville-Montgomery County Employees Spouse Premium Life with Accidental Death and Dismemberment Premium for sample benefit amounts Rates are based on 10 pay periods per year Employee and Spouse premiums are calculated separately. Spouse premiums will be calculated based on the Employee s age. Refer to Program Specifications for your maximum benefit amounts. Benefits and premium amounts reflect age reductions. AGE Rate per $1,000 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 < $0.72 $1.44 $2.16 $2.88 $3.60 $4.32 $5.04 $5.76 $6.48 $ $0.78 $1.56 $2.34 $3.12 $3.90 $4.68 $5.46 $6.24 $7.02 $ $0.96 $1.92 $2.88 $3.84 $4.80 $5.76 $6.72 $7.68 $8.64 $ $1.38 $2.76 $4.14 $5.52 $6.90 $8.28 $9.66 $11.04 $12.42 $ $2.10 $4.20 $6.30 $8.40 $10.50 $12.60 $14.70 $16.80 $18.90 $ $3.00 $6.00 $9.00 $12.00 $15.00 $18.00 $21.00 $24.00 $27.00 $ $4.32 $8.64 $12.96 $17.28 $21.60 $25.92 $30.24 $34.56 $38.88 $ $6.90 $13.80 $20.70 $27.60 $34.50 $41.40 $48.30 $55.20 $62.10 $ $12.24 $24.48 $36.72 $48.96 $61.20 $73.44 $85.68 $97.92 $ $ $17.16 $34.32 $51.48 $68.64 $85.80 $ N/A N/A N/A N/A $36.72 $73.44 $ $ $ $ N/A N/A N/A N/A This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. Example: Use this formula to calculate premium for benefit amounts over $50,000. Age Rate Per $1,000 X Benefit In $1,000 s = Cost Example: X 95 = $18.24 Dependent Children Rate = $2.40 per Pay Period X = Premium covers all dependent children regardless of the number of children.
4 Definitions Accelerated Death Benefit AD&D Conversion Guarantee Issue Term Life Exclusion: Suicide When diagnosed as terminally ill (having 12 months or less to live), you may withdraw up to 75% of your life insurance coverage to a maximum of $250,000. The death benefit will be reduced by the amount withdrawn. To qualify, you satisfied the Active Work rule and have been covered under this policy for at least 12 months. Check with your tax advisor or attorney before exercising this option. Accidental Death and Dismemberment (AD&D) insurance provides specified benefits for a covered accidental bodily injury that directly causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from a covered accident, both the life and the AD&D benefit would be payable. If you terminate your employment or become ineligible for this coverage, you have the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination without Evidence of Insurability. Conversion election must be made within 31 days of your date of termination. For timely entrants enrolled within 31 days of becoming eligible, the Guarantee Issue amount is available without any Evidence of Insurability requirement. Evidence of Insurability will be required for any amounts above this, for late enrollees or increase in insurance and it will be provided at your own expense. Coverage provided to the designated beneficiary upon the death of the insured. Coverage is provided for the time period that you are eligible and premium is paid. There is no cash value associated with this product. Benefits will not be paid if the death results from suicide within two years after coverage is effective. May apply if employee contributes toward the premium. Additional Benefits BeneficiaryConnect SM TravelConnect SM Support services for beneficiaries who have experienced a loss. Travel assistance services for employees and eligible dependents traveling more than 100 miles from home. For assistance or additional information Contact Lincoln Financial Group at (800) or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National Corporation Group Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligations.
5 ENROLLMENT FORM FOR GROUP INSURANCE OPEN ENROLLMENT ONLY Please Use Ink or Type GROUP ID: GROUP POLICY #: CMBOARD A. Employee Information (Complete for ALL Enrollments) Employer Name/Company Name (Please Print) Clarksville-Montgomery County Employees Insurance Trust The Lincoln National Life Insurance Company P.O. Box 2616, Omaha, NE Phone: (800) Fax: (877) Billing Division or Location: County B.O.E Government County Employer ZIP State Employee Last Name First Name Middle Initial Social Security Number Date of Birth Spouse Last Name First Name Middle Initial Social Security Number Date of Birth Gender: Male Female Marital Status: Married Single Home Phone ( ) Completed By Employer Average Hours Worked Per Week: Occupation: Work Phone ( ) Earnings: Hourly Monthly Weekly Yearly $ B. Product Selection (Complete for ALL Enrollments) Voluntary Coverage NOTE: Please mark the box or boxes for each coverage you are applying for. All coverage amounts are subject to the limitations and exclusions as stated in the policy. CLASS TYPE OF COVERAGE AMOUNT OF COVERAGE TOTAL PREMIUM 03 Voluntary Employee Life/AD&D Insurance Yes No $ $ 03 Voluntary Spouse Life/AD&D Insurance Yes No $ $ 03 Voluntary Dependent Child Benefit Yes No $10,000 $ C. Beneficiary Information (Complete ONLY for Life or AD&D Enrollments) Primary Beneficiary's Last Name First MI Relationship of Beneficiary Social Security Number Contingent Beneficiary's Last Name First MI Relationship of Beneficiary Social Security Number Note: A Contingent Beneficiary will receive benefits only if the Primary Beneficiary does not survive you. If you wish to designate more than one Primary or Contingent Beneficiary, please attach a separate sheet of paper. E. Request for Coverages This coverage has been offered to me and after careful consideration of the benefits, I have decided to: REQUEST COVERAGE for which I am or may become eligible under the group policies issued by The Lincoln National Life Insurance Company. I hereby apply for group insurance, for which I am eligible or may become eligible. If contributions are required, I authorize my employer to deduct premiums from my salary. NOT ENROLL myself in the Program. I understand that if I apply for coverage at a later date, and if a physical examination or further medical information is required, it will be at my own expense. NOT ENROLL my dependents in the Program. I understand that if I apply for coverage for my dependents at a later date, and if a physical examination or further medical information is required, it will be at my own expense. NOTE: A PERSON COMMITS INSURANCE FRAUD, IF HE OR SHE SUBMITS AN APPLICATION OR CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT WITH INTENT TO DEFRAUD (OR KNOWING THAT HE OR SHE IS HELPING TO DEFRAUD) AN INSURANCE COMPANY. The insurance requested on this enrollment form will not be effective until approved by the Group Insurance Service Office of The Lincoln National Life Insurance Company, and the initial premium is paid to The Lincoln National Life Insurance Company. A delayed effective date will apply if the employee is not actively at work, or a dependent is in a period of limited activity on the date insurance would otherwise take effect. Employee Full Name: Employee Signature: Date: GLAD 4 11/00 Rev. 04/07 TN
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Xavier University All Full-Time Employees excluding Jesuit Employees Life Benefit Employee Spouse
More informationOrange County Transportation Authority- Administrative Group
Group Life Insurance SUMMARY OF BENEFITS Life and AD&D Sponsored by: All Full-Time Administrative Employees and Employees represented by Transportation Communications Union (TCU) Life Employee Amount Two
More informationVoluntary Term Life Program Specifications Prepared For. Gunnison County
Voluntary Term Life Program Specifications Prepared For Gunnison County The Lincoln National Life Insurance Company 8801 Indian Hills Drive, Omaha, NE 68114 VOLUNTARY TERM LIFE INSURANCE Employee Gunnison
More informationVoluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Quantum 3D, Inc. Effective date: January 1, 2010 Life Benefit Employee Spouse Dependent Amount
More informationVoluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Lane Community College Life Benefit Employee Spouse Dependent Amount Choice of $10,000 increments
More informationVoluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS
Westminster College Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Westminster College Life Benefit Employee Spouse Dependent Amount Choice of
More informationVoluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Waynflete School Life Benefit Employee Spouse Dependent Amount Choice of $10,000 increments Not
More informationVoluntary Life Insurance Summary
Voluntary Life Insurance SUMMARY OF BENEFITS Sponsored by: Spring Arbor University Life Benefit Employee Spouse Dependent Amount Choice of $10,000 increments Not to exceed 7 times your salary. Employees
More informationSUMMARY OF BENEFITS. Amount One Times Annual Salary rounded to the next higher $1,000. Minimum Amount $10,000. Maximum Amount $100,000
Group Life Insurance SUMMARY OF BENEFITS Life and AD&D Sponsored by: University of Dallas Life Amount One Times Annual Salary rounded to the next higher $1,000 Minimum Amount $10,000 Maximum Amount $100,000
More informationVoluntary Life Insurance SUMMARY OF BENEFITS
Voluntary Life Insurance SUMMARY OF BENEFITS Sponsored by: Educational Service Center of Central Ohio Life Benefit Employee Spouse Dependent Amount Choice of $10,000 increments Not to exceed 5 times your
More informationSUMMARY OF BENEFITS. Life Benefit Employee Spouse Dependent Employee must elect coverage for Spouse or dependents to be eligible.
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Douglas Cherokee Economic Authority Life Benefit Employee Spouse Dependent Employee must elect
More informationhy should you consider purchasing life insurance protection at your workplace?
W hy should you consider purchasing life insurance protection at your workplace? Employees find significant value in obtaining non-medical products in their workplace. Many of us lead busy lives and seldom
More informationThe Prudential Insurance Company of America
Basic Term Life Insurance Accidental Death and Dismemberment Insurance Optional Term Life Insurance Dependent Term Life Insurance Optional Accidental Death and Dismemberment Insurance The Prudential Insurance
More informationContinue your Aetna life insurance coverage with these options.
P.O. Box 24846 Cleveland OH 44124-0846 Group Life Insurance Operations Phone: 1-877-503-3448 Fax: 440-386-2662 Continue your Aetna life insurance coverage with these options. Thank you for your interest
More informationThe Need for Life Insurance
United of Omaha Life Insurance Company Companion Life Insurance Company The Need for Life Insurance Life insurance is a simple answer to a very difficult question: How will my loved ones manage financially
More informationMississippi State and School Employees Life Insurance Plan Group Term Life Insurance
Mississippi State and School Employees Life Insurance Plan Group Term Life Insurance The Health Insurance Management Board is authorized by state law to provide certain specified group life insurance benefits
More informationEgyptian Area Schools term life insurance program
FOR GROUP BENEFITS EduBenefit Egyptian Area Schools term life insurance program Supplemental group term life insurance SM Help secure their futures You can help make sure your loved ones can continue to
More informationState of Louisiana All Employees
State of Louisiana All Employees Basic Term Life Insurance Basic plus Supplemental Term Life Insurance Accidental Death and Dismemberment Insurance Dependent Term Life Insurance The Prudential Insurance
More informationGroup Term Life Insurance Portability Election Form
Group Term Life Insurance Portability Election Form You may apply for Group Term Life Insurance coverage under Prudential s portability option. This option may be available to you and your covered dependents
More informationApplication for Conversion of Group Term Life & Accidental Death Insurance Aetna Life Insurance Company
Application for Conversion of Group Term Life & Accidental Death Insurance Aetna Life Insurance Company Application and payment of the first premium must be made within the time limit shown in your certificate
More informationGroup Plan Benefits Life, AD&D, STD, LTD
BENEFIT HIGHLIGHTS ILLUSTRATION Canadian National - Wisconsin Central General Committee of Adjustment Group Plan Benefits Life, AD&D, STD, LTD Railroad Retirement can fall short of giving you complete
More informationNew Employee Enrollment. COMMONWEALTH OF KENTUCKY Enrollment Brochure and Booklet Certificate
New Employee Enrollment COMMONWEALTH OF KENTUCKY Enrollment Brochure and Booklet Certificate Group Term Life Insurance The Commonwealth of Kentucky is pleased to offer you Group Term Life Insurance and
More informationRockford Public Schools District 205 Benefits Enrollment Presentation. Underwritten by: United of Omaha Life Insurance Company
Rockford Public Schools District 205 Benefits Enrollment Presentation Underwritten by: United of Omaha Life Insurance Company 15184 Topics Benefits and features How to enroll for coverage Questions What
More informationGroup Term Life and Accidental Death & Dismemberment (AD&D) Insurance
Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Issued by: Standard Insruance Company For new employees of ENROLLMENT CONDUCTED BY: 1410 Piedmont Drive E. Tallahassee, FL 32308 800.330.6115
More informationMetLife Term Life Insurance Plan
MetLife Term Life Insurance Plan Basic Employee Life & AD&D Insurance Optional Employee Life & AD&D Insurance Basic Employee Life & AD&D Insurance This insurance is payable for death from any cause to
More informationGROUP INSURANCE STATE OF LOUISIANA
Y O U R E N R O L L M E N T K I T GROUP INSURANCE Basic Term Life Insurance Basic Term Life & Supplemental Term Life Insurance Accidental Death & Dismemberment (AD&D) Insurance Dependent Term Life Insurance
More informationTHE STANDARD LIFE AND AD&D INSURANCE
THE STANDARD LIFE AND AD&D INSURANCE Standard Insurance Company provides Life, Accidental Death and Dismemberment (AD&D) for eligible Bloomfield School District (BSD) employees and dependents Basic Term
More informationContinue your Aetna life insurance coverage with this option.
P.O. Box 24846 Cleveland OH 44124-0846 Group Life Insurance Operations Phone: 1-877-503-3448 Fax: 440-386-2662 Continue your Aetna life insurance coverage with this option. Thank you for your interest
More informationImportant Information About MetLife s Portability Option
Election of Portable Coverage Form For Group Life and Accidental Death & Dismemberment (AD&D) Insurance Coverage Metropolitan Life Insurance Company Important Information About MetLife s Portability Option
More informationToll-Free Phone Numbers. FAX Numbers
Lincoln Life & Annuity Company of New York Service Office Address: PO Box 2616, Omaha, NE 68103-2616 Home Office: Syracuse, NY toll free (800) 423-2765 www.lincolnfinancial.com GROUP ADMINISTRATION REFERENCE
More informationTerm Life Insurance. Developed for the Employees of Iona College. 811761 a 06/12
Term Life Insurance Developed for the Employees of Iona College 811761 a 06/12 Who Needs Life Insurance? You do. Single or married. Buying your first home or preparing for retirement. Raising children
More informationThe Prudential Insurance Company of America
The Prudential Insurance Company of America Record Keeping Services PO Box 13676 Philadelphia, PA 19176 (800) 778-3827 Dear New Uniformed Firefighter: The City of Chicago is committed to offering a benefits
More informationImportant Information About MetLife s Portability Option
Metropolitan Life Insurance Company Election of Portable Coverage Form For Group Life Insurance Coverage Important Information About MetLife s Portability Option You re in a time of transition, and MetLife
More informationAnnual Benefits Election 2012
Medical Insurance Last Name First Name M.I. Address Date Employed Full-Time City Annual Salary State Zip Position Home Phone ( ) Work Location Social Security # Work Phone ( ) UnitedHealthcare Standard
More informationLIFE INSURANCE SUMMARY
LIFE INSURANCE SUMMARY Your family can count on your paycheck to meet day-to-day expenses while you are actively at work, but it is important to plan for their financial security in the event of your death.
More informationUnited of Omaha Life Insurance Company A Mutual of Omaha Company. voluntary term life insurance. work. for you UGC8914_0409
United of Omaha Life Insurance Company A Mutual of Omaha Company voluntary term life insurance Benefits work that for you UGC8914_0409 Eligibility All full-time employees, who are citizens or permanent
More informationExtra Protection For Your Family
IDAHO Extra Protection For Your Family Group Decreasing Term Life Insurance The Voice for Public Pensions The Prudential Insurance Company of America 0182925-00001-00 The Voice for Public Pensions Dear
More informationContinue your Aetna life insurance coverage with these options.
Life Enrollment & Billing Services 151 Farmington Avenue, RT32 Hartford, CT 06156 Need more information? Log onto www.aetna.com, or call us at 1-800-523-5065 Continue your Aetna life insurance coverage
More informationSupplemental Life and AD&D Insurance Benefit Highlights
Supplemental Life and AD&D Insurance Benefit Highlights Benefit Highlights Southern Orthopedic Associates What is supplemental life and AD&D insurance? Am I eligible? When can I enroll? When is it effective?
More informationSPECIAL OFFER TO ELIGIBLE FEDERAL GOVERNMENT EMPLOYEES $50,000 Group Term Life Insurance
SPECIAL OFFER TO ELIGIBLE FEDERAL GOVERNMENT EMPLOYEES $50,000 Group Term Life Insurance New York Life Insurance Company 1, one of the largest and most respected life insurance companies in the nation
More informationToll-Free Phone Numbers. FAX Numbers
The Lincoln National Life Insurance Company, PO Box 2616, Omaha, NE 68103-2616 toll free (800) 423-2765 www.lincolnfinancial.com GROUP ADMINISTRATION REFERENCE GUIDE Welcome! Enclosed you will find guidelines
More informationExtra Protection For Your Family
ILLINOIS Extra Protection For Your Family Group Decreasing Term Life Insurance National Conference on Public Employee Retirement Systems The Prudential Insurance Company of America 0204989-00002-00 Ed.
More informationVOLUNTARY GROUP TERM LIFE INSURANCE:
VOLUNTARY GROUP TERM LIFE INSURANCE: This plan offers you and your dependents an excellent opportunity to purchase affordable group term life insurance on a payroll deduction basis. The important plan
More informationEmployee Term Life Accidental Death & Dismemberment. Dependent Term Life. Short-Term Disability. Long-Term Disability
Lafayette Life Insurance Company True Group Product Information For Groups with 10+ Employees Employee Term Life Accidental Death & Dismemberment Dependent Term Life Short-Term Disability Long-Term Disability
More informationDependent Term Life Insurance Plan
Dependent Term Life Insurance Plan Lowe s provides the Lowe s Dependent Term Life Insurance Plan (the Dependent Term Life Plan Option), insured through MetLife, to help with expenses related to the death
More informationGroup Term Life Insurance Portability Election Form
Group Term Life Insurance Portability Election Form If you have been actively employed prior to leaving your employer, and you are not retiring or disabled, you may apply for Group Term Life Insurance
More informationIncome Protection. Archdiocese of St. Louis Policy# 677885. Supplemental Life Insurance. Administration Guide for Supplemental Life Insurance :
Income Protection Supplemental Life Insurance Administration Guide for Supplemental Life Insurance : Archdiocese of St. Louis Policy# 677885 Eligibility Enrollment Period All full-time active employees
More informationCERTIFIES THAT Group Policy No. GL 000400001000-19783 has been issued to
The Lincoln National Life Insurance Company A Stock Company Home Office Location: Fort Wayne, Indiana Group Insurance Service Office: 8801 Indian Hills Drive, Omaha, NE 68114-4066 (800) 423-2765 Online:
More informationEmployee Life and AD&D Insurance
Employee Life and AD&D Insurance Employee Life and Accidental Death & Dismemberment (AD&D) Insurance provides a source of income to your beneficiary(ies) in the event of your death while you are employed
More informationGroup and Voluntary Life and AD&D
Group and Voluntary Life and AD&D Voluntary Life and AD&D Coverage for You and Your Family Voluntary Life and AD&D coverage is a great way to help your loved ones manage their financial needs in case there
More informationSymetra Life Insurance Plan for County of Albemarle
Symetra Life Insurance Plan for County of Albemarle - Employee Plan - For You Symetra s Group Term Life Insurance is a yearly renewable, supplemental group term life insurance with monthly premium rates
More informationAll Rates listed are Monthly per $1,000 of coverage. Age-band Employee Spouse
Tracking ID: 09221437 Proposal Prepared for: New Albany Floyd County Schools Prepared by: Quinn Pearl Number of employees: 2,253 City, State: New Albany, IN Date Prepared: 9/22/2014 Plan Selected: Group
More informationInformation About You Employee ID (if not available, then Social Security Number): Date of Birth: Date of Hire: Earnings:
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY One Hartford Plaza, Hartford, CT 06155 (A stock insurance company) PALOMAR COMMUNITY COLLEGE: FBC Benefits Enrollment Form Instructions Please enter all required
More informationGroup Term Life Insurance Continuation Form
Group Term Life Insurance Continuation Form Employees must be actively at work at the time of employment termination or retirement in order to be eligible for the continuation plan. Coverage terminates
More informationCERTIFICATE OF GROUP LIFE INSURANCE
The Lincoln National Life Insurance Company A Stock Company Home Office Location: Fort Wayne, Indiana Group Insurance Service Office: 8801 Indian Hills Drive, Omaha, NE 68114-4066 (402) 361-7300 CERTIFIES
More informationCITYWIDE ASSOCIATION OF LAW ASSISTANTS OF THE CIVIL, CRIMINAL AND FAMILY COURTS IN THE CITY OF NEW YORK WELFARE TRUST FUND
CITYWIDE ASSOCIATION OF LAW ASSISTANTS OF THE CIVIL, CRIMINAL AND FAMILY COURTS IN THE CITY OF NEW YORK WELFARE TRUST FUND C/O ADMINISTRATIVE SERVICES ONLY, INC 303 MERRICK ROAD, SUITE 300 LYNBROOK, NY
More informationGroup Voluntary Accidental Death and Dismemberment Insurance
California Association of Professional Scientists Group Voluntary Accidental Death and Dismemberment Insurance California Association of Professional Scientists S T A N D A R D I N S U R A N C E C O M
More informationGroup Basic Life and AD&D Insurance
Group Basic Life and AD&D Insurance City & County of Denver S T A N D A R D I N S U R A N C E C O M P A N Y City & County of Denver Group Basic Life and AD&D Insurance WHAT ARE MY BASIC LIFE AND AD&D BENEFITS?
More information2013 Open Enrollment. Richardson Independent School District
Richardson Independent School District 2013 Open Enrollment Supplemental Term Life Insurance Short Term & Long Term Disability Accidental Death & Dismemberment When is Open Enrollment? Open enrollment
More informationCONTINUATION OF GROUP TERM LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE EMPLOYER INSTRUCTIONS
CONTINUATION OF GROUP TERM LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE EMPLOYER INSTRUCTIONS Employees who have either terminated or lost coverage have 31 days from either their termination
More informationCOLORADO HIGHER EDUCATION INSURANCE BENEFITS ALLIANCE TRUST (CHEIBA TRUST)
Mutual of Omaha Insurance Company Voluntary Accidental Death and Dismemberment Insurance Program Made Available By: COLORADO HIGHER EDUCATION INSURANCE BENEFITS ALLIANCE TRUST (CHEIBA TRUST) MC31649_1106
More informationGROUP UNIVERSAL LIFE (GUL) & ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) PROGRAM FREQUENTLY ASKED QUESTIONS (FAQs) MAY 2015
GROUP UNIVERSAL LIFE (GUL) & ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) PROGRAM FREQUENTLY ASKED QUESTIONS (FAQs) MAY 2015 Minnesota Life is the underwriter of the State of Delaware s GUL and AD&D Program.
More informationTHE AVAYA INC. LIFE INSURANCE PLANS Active Represented SUMMARY PLAN DESCRIPTION. Effective 1/1/2013 Last Updated 3/31/2013
THE AVAYA INC. LIFE INSURANCE PLANS Active Represented SUMMARY PLAN DESCRIPTION Effective 1/1/2013 Last Updated 3/31/2013 Helpful search tools: Table of Contents (TOC): Each item on the TOC is a hyperlink
More informationLife Insurance Plan. for. Full-Time Appointed. Employees. IndianaUniversity. University Human Resource Services Effective January 1, 2004
Life Insurance Plan for Full-Time Appointed Employees of IndianaUniversity University Human Resource Services Effective January 1, 2004 This booklet is designed to summarize the group Life Insurance Plan
More informationEmployee Compensation & Benefits Handbook
GROUP LIFE INSURANCE PLAN S ELIGIBILITY... 2 INTRODUCTION... 2 GROUP LIFE INSURANCE PLANS... 3 Full-time regular employees, Full-time regular employees represented by UWUA Locals 102, 118, 126, 140, 270,,
More informationAdditional Life Coverage Highlights Kent State University
Additional Life Coverage Highlights Additional Life Insurance will provide Basic Life coverage from Standard Insurance Company. If you are enrolled in Basic Life, you may also apply for Additional Life
More informationVoluntary Term Life Benefit Summary
Policyholder: Linfield College Voluntary Term Life Benefit Summary Effective Date: 04/01/2015 This chart provides you a brief summary of the key benefits of the life coverage available from Principal Life
More informationPublic Schools Voluntary Life Benefit Summary Class 1
Yes Prep Public Schools Voluntary Life Benefit Summary Class 1 - All Eligible Full-Time Teachers Full-time Employee Requirement Life Amount An eligible employee is a full-time permanent employee authorized
More informationGroup Term Life Insurance Portability Election Form
Group Term Life Insurance Portability Election Form If you have been actively employed prior to leaving your employer, and you are not retiring or disabled, you may apply for Group Term Life Insurance
More informationMcAllen Independent School District Policy # 219632
Term Life Insurance and AD&D Coverage Highlights McAllen Independent School District Policy # 219632 Please read carefully the following description of your Unum Term Life and AD&D insurance plan. Your
More informationYou can convert your term life insurance.
Turning promise into practice TM You can convert your term life insurance. When you terminate employment or insurance eligibility, or you retire, you have options available regarding your current group
More information2014 CITY OF MILWAUKEE VOLUNTARY AND FAMILY LIFE INSURANCE INFORMATIONAL BROCHURE
2014 2014 CITY OF MILWAUKEE VOLUNTARY AND FAMILY LIFE INSURANCE INFORMATIONAL BROCHURE Group Life Insurance Administrator c/o Employes Retirement System 789 North Water Street Suite 300 Milwaukee, Wisconsin
More informationAge-band. Age-band Spouse. Uni-tobacco Uni-tobacco Uni-tobacco Uni-tobacco Uni-tobacco
LAKEVILLE ISD 194: Group Term Life with Waiver of Premium and AD&D for, Spouse and Dependent Children $10,000 $25,000 $50,000 $100,000 $200,000 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69
More informationLake Havasu Public Schools Employees Benefit Trust
Lake Havasu Public Schools Employees Benefit Trust Overview of Unum Benefits / August 2014 Basic Life and Accidental Death & Dismemberment Voluntary Life and Accidental Death & Dismemberment Voluntary
More informationContinue your Aetna life insurance coverage with these options.
P.O. Box 24846 Cleveland OH 44124-0846 Group Life Insurance Operations Phone: 1-877-503-3448 Fax: 440-386-2662 Continue your Aetna life insurance coverage with these options. Thank you for your interest
More informationPhysicians Benefits Trust Life Insurance Company Group Health Benefits Program
Physicians Benefits Trust Life Insurance Company Group Health Benefits Program Employee Application & Change of Coverage Form (For groups of 51 or more employees) ALL ELIGIBLE EMPLOYEES MUST COMPLETE THIS
More informationGROUP BENEFIT PROGRAM HIGHLIGHTS
Group Disability GROUP BENEFIT PROGRAM HIGHLIGHTS When the death of a family provider occurs, families find themselves facing not only the loss of a loved one but also the loss of their financial security.
More informationVOLUNTARY GROUP TERM LIFE INSURANCE: GUARANTEED ISSUE:
VOLUNTARY GROUP TERM LIFE INSURANCE: This plan offers you and your dependents an excellent opportunity to purchase affordable group term life insurance on a payroll deduction basis. The important plan
More informationLife and Disability. Focusing the power of small business
Life and Disability The Small Business Association of Michigan offers an enhanced life and disability program that is unique for small business owners and their employees. Focusing the power of small business
More informationGroup Additional Life and Accidental Death and Dismemberment (AD&D) Insurance FOR EMPLOYEES OF DOUGLAS COUNTY SCHOOL DISTRICT
Group Additional Life and Accidental Death and Dismemberment (AD&D) Insurance FOR EMPLOYEES OF DOUGLAS COUNTY SCHOOL DISTRICT Answers to your questions about coverage from Standard Insurance Company STANDARD
More informationApplication for Conversion of Group Term Life and Accidental Death Insurance Aetna Life Insurance Company
Application for Conversion of Group Term Life and Accidental Death Insurance Aetna Life Insurance Company Application and payment of the first premium must be made within the time limit shown in your certificate
More informationHow You Can Continue Your Group Term Life Insurance (Portability)
1-888-252-3607 How You Can Continue Your Group Term Life Insurance (Portability) What is Portability? Portability or porting is an optional feature chosen by your former employer. It allows employees and
More informationNew York Medical College Policy and Procedure Manual
Section: HUMAN RESOURCES Date: May 23, 2008 Subject: LIFE INSURANCE Page 1 of 9 I. Purpose New York Medical College Policy and Procedure Manual Supercedes: 7/20/93 To establish an employee benefit plan
More informationGroup Voluntary Accidental Death And Dismemberment Insurance
Group Voluntary Accidental Death And Dismemberment Insurance For Employees of Employers Participating in the Washington Counties Insurance Fund Answers To Your Questions About Coverage From The Standard
More informationFor groups with 51+ employees: Affordable Group Term Life Insurance Short and Long Term Disability Insurance Optional Group Term Life Insurance
HEALTH Life and disability protection DENTAL VISION LIFE DISABILITY EAP For groups with 51+ employees: Affordable Group Term Life Insurance Short and Long Term Disability Insurance Optional Group Term
More informationCompanion Life Insurance Company. Administrative Guide
Companion Life Insurance Company Administrative Guide Contents Section.Title About Your Companion Life Administrative Guide I. Online Services II. New Enrollments Who is Eligible for insurance? Processing
More informationMetLife Term Life Insurance
MetLife Term Life Insurance Effective Date: January 1, 2014 pending underwriting approval if indicated OPTIONAL EMPLOYEE LIFE INSURANCE Optional Life coverage is available to you in the amounts listed
More informationHumana Life. Humana.com GNHJ3DVEN 1114
Humana Life Humana.com GNHJ3DVEN 1114 Making sure the quality of life goes on Here are a few more reasons to choose Humana life: Families speak directly with staff who are specially trained to handle
More informationDependent Life Insurance Plan
Dependent Life Insurance Plan Lowe's offers the Lowe's Dependent Term Life Insurance Plan (the Dependent Term Life Plan Option), insured through MetLife, to help with expenses related to the death of a
More informationA NEW, IMPROVED GROUP INSURANCE PLAN" GROUP LIFE/ACCIDENTAL DEATH & DISMEMBERMENT & SHORT TERM DISABILITY INSURANCE PLAN OFFER
A NEW, IMPROVED GROUP INSURANCE PLAN" GROUP LIFE/ACCIDENTAL DEATH & DISMEMBERMENT & SHORT TERM DISABILITY INSURANCE PLAN OFFER In an ongoing effort to reduce your cost of doing business and provide exceptional
More informationCity of Moberly. Your Group Life and Accidental Death and Dismemberment Plan
City of Moberly Your Group Life and Accidental Death and Dismemberment Plan Identification No. 420359 011 Underwritten by Unum Life Insurance Company of America 12/4/2015 CERTIFICATE OF COVERAGE Unum
More informationTown of Mansfield 6 Park Row, Mansfield, Massachusetts 02048
Town of Mansfield 6 Park Row, Mansfield, Massachusetts 02048 FREQUENTLY ASKED QUESTIONS (FAQ s) Life Insurance Programs (1) Life Insurance (Referred to as the Basic Life Insurance Program ) (See the Summary
More informationBradley University Policy # 133255
Voluntary Term Life and AD&D Insurance Coverage Highlights Bradley University Policy # 133255 Please read carefully the following description of your Unum Voluntary Term Life and AD&D insurance plan. Your
More informationDependent Life Insurance Plan
Dependent Life Insurance Plan Lowe's offers the Lowe's Dependent Term Life Insurance Plan (the Dependent Term Life Plan Option), insured through Cigna, to help with expenses related to the death of a dependent.
More informationBase Plan Benefits Two Plan Options
Endowment at Age 100 Life Insurance Paul Revere s Endowment at Age 100 is an individually owned life insurance plan with guaranteed level premiums, guaranteed cash values and a guaranteed death benefit.
More information